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HomeMy WebLinkAbout18592-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No 219399 Date SEPT. 28, 1990 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 1255 DONNA DRIVE MATTITUCK House No. Street Hamlet County Tax Map No. 1000 Section 115 Block I6 Lot 12 MAP OF DEEP HOLE Subdivision CREEK ESTATES Filed Map No. 4256 Lot No. 62 conforms substantially to the Application for Building permit heretofore filed in this office dated OCT. 13, 1989 pursuant to which Building Permit No. 185922 dated OCT. 24, 1989 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DWELLING WITH ATTACHED GARAGE AND AMENDED TO INCLUDE DECK. The certificate is issued to MOHRING ENTERPRISES INC. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 89-SO-98 SEFT. 28, UNDERWRITERS CERTIFICATE NO. NI46196 AUGUST 28, 1990 PLUMBERS CERTIFICATION DATED CHARLES SANDERS SEPT. 24 1990 v~ i1d ng Inspector Rev. 1/81 rows xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 18592 U 15...... N _ Z Date ...`O ~ Permission is hereby granted to: , ....~~..17..~1. ~~L'r........... ~~/J ....R...,.... ct premises Ivcated at .../.ea..:x!..~~.......:~..~L~.....~ . Cvunty Tax Map No. 1000 Section ......~1~.... Block .....~~2.......... Lot No......~°Z......... pursuant to application doted ~ 19. and approved by the Building Inspector.e~ Fee .r4~:.......... . uildin Inspector Rev. 6/30/80 Form No. 6 TOWN l` d SOt'THOLD BUILD'.:G rgrARTMENT cia1.L '55-18C_ APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2J10 of 1~ lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6, Submit Planr~ix~g Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years -'$10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $1.y5.0g0, Commercial $15.00 ~ Date ...~:.l:..C.d New Construction.... Y..... Old Or Pre-existing Bui~lding Location of Property. ~qf;'~i .~0. ;2 ~4J~s~lfJ....> :?~ll~~ .............~`~T./-/T.4~. ~C~ > ~U~`~, House No. Street Hamlet Onwer or Owners of Property.. Q.:y.~IJS~ ~....~N. TGles~iQ///S~,S , , ;1;V,c . ~ . County Tax Map No 1000, Sect/i~on.... 11~......Block.....~(u ........Lot...~.°~ Subdivision.~~F~~ ..~°~~..5-ce~~l~ .~:~1~TE-.Filed Map...~i~a~~(.~j..Lot......~0. v~ Permit No..~.~'.?~.F3.°~~.Date Of PgqerppmitlQ'.:~.`?~~.~...Applicant~o/f:4i!L~.~a..~'YT..:~.V~..... Health Dept. Approval...~.~~.:~~. 0. ...........Underwriters Approval..4K .~~~.~e ~ / Nd........... Planning Board Approval Request for: Temporary Certificate........... Final Certicate...ti/.... Eee Submitted: $..°~i~ ~ /y(%%~ ~ `{6 Sy'e2. deg- fy9D APPLICANT G''a 2.1y3`/9 BUILDER AND LAND DEVELOPER 323 GLEN COVE AVENUE SEA CLIFF, NEW YORK i 7579 (576)671-0481 D ~ , L~ ~1 T~'~9 UN ~srra~~~,i` January 17, 1990 Town of Southold Building Dept. Town Hall Main Road Southold, New York 11971 Re: Donna Drive, Mattituck Building Permit #185922 Dear Sir: Enclosed please find the Foundation Location Survey in regard to the above captioned property. If you have any questions, feel free to give me a call. Ve truly yours, RichardG ldohri~~2~ g = c~~FFa~/(~"~ TEL. 7G5-1802 ~p OG~ ~ TOWN OF SOUTIIOLD OPFiCE Or BUILDING INSPECTOR a c+w ~ r P.O. DOY 728 d+~, ~ u' ~ TONN FIALL ~~y!/O~ ~ ~~0<' SOUTIlOLD, N.Y. 1197] /Y~qo ' To 54hom This May Concern, ' We are unable to complete your Certificate of Occupancy because ,of the following reasons. /f An application for Certificate of Occupancy i;; not on Li lc. ~N~~OQ~- / 'ca e on i e. The check is (o.a~~l/not on file.) No llcalL-h Dept. Approval on file. No final i.nspecCion has been made. k'lea~c cont--act our office on this matter. Thank you for your cooperation. I3ui]di.nq Permit fk ~ ~ Z I3u.ilding Dcpt. ***/tom/ NO Plumber Solder Certificate on file. ( all permits involving plumbing being .issued after April 1,1984 ) . 5 ~y ~ 'gE1~.7G5.1802 c~UFFOL~~. To~evN or s~u~~~a.D lII ~~"'.c QI=FILE Qt^ BUILDING INSPEG"1"UR P.q.13gX 72$ t°s+ "'i' ~ TQWN He1.LL .,1~~~~~ ~ SQUTIIQI,D, N.Y, 11971 d4 ' C E R T x F 2 C -A_T I O N ' Datc~~~ Building Permit Na. ~~y~ ~i Ownez ! !0%6/~l~l G' ~~~N~r~-,~~J, (pl4ase prints PlutrWaz~/~/a/r/fS ~~/~/?~7~GZS' T~t-,~ (plcasE print? /3 ae ~ I certify that the solder used in the water supply s. stem contains less than 2/10 of lb lead. - (plumber`s sign.~?.~.-,.~. SUwVN EF, CONC~gO NfY7MY %7BI.IC, &aw d NewYak No.90+l618f iB sworn to befc~s2o ma this ~ ~ 0 9~- __.~,day of,~~ ,rte J , 19 ~'0. -~~`~'Noi;ary Pu Lic ttotarj rublic,~cti-~~~~~ County ~i THE NEW YORK BOARD OF FIRE UNDERWRITERS ~~sra: 1•pQ0(t~t1 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date ,}~U(N(.I(>'f` ?S, I ~~il APP/ication No. on file j`~4~ 41 k4915~`l E) ti~ I (#(a ~ c)fn THIS CERTIFIES THAT only [he electrical equipment os described 6eloty and introduced by the applicant named on the above application number in the premises of f~10AH7NG i;tJ'.17;k'FI2TS~8, 31.2 N./~ 1H7~1~1~ ~l~,7:VNJy Ail"l"t"r'i'1lGFi, N X~ Boserne GAPi f (}1J't' 1.13 1 iii; ' in the, follouinq kx•atiQnj nt ? 1st FY. ? 2nd F'l. .Section B/ock Lot ?x 7(rlP.iT f19, 1,11911 u~as exmnined on arzd found to 6e in camp/iance with the reKluiremeats qj this Roard. FIXTURE ECEPTACLE$ SWITCHES FIXTURES RANGES COOKING DECK$ OVENS DISHWASHERS EXHAUST FANS nOUTLETS INCANDESCENT f1UORE5CENT OTHER PMl K W. AMT K.W AMi K.W AMi. K W AMi H P 4 Yw 1 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS $PECIAI REC'PT TIME CLOCKS gEll UNIT HEATERS MULTI.OUTLET DIMMERS AMT. K. W. OIL H P GA$ H, P AMi NO. A. W. G AMi AMP AMT. AMPS TRANS. pMT. H p SYSTEMS pMT. WATTS NO.OF FEET 3 E` l 3<1 SERVICE DISCONNECT NO.OF S E R V { C E AMT AMP iTPE METER I 4W I a. 3W J,e' 3W 3X 4W NO OF CC COND. A. W G NO OF H6LEG A' W G' NO OF NEUTRALS A W G' y EQUIP. PER % OF CC. COND. OF HbLEG OF NEUTRAL 1 zno X11 a x ~ zfo 'I z,n OTHER APPARATUS: r11,1xrrTt,~ rtf,rrsr; 1~r,~~r,~t~~~a~~;._r rt~r.c.r; 1. ~ - GFNk;Rt#1.L L1LP.C;rR,1s°At, C,ONTIIA 1.1<'.1~53.i-tit ~ ~ ~ .zo~12 srfl~~ra.,;:v tLtLnc1~, ~}1S'i' 34F~.~]?DW, NX; '1.'1554 GENERAL MANAGER Pert I This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credantials. =®PY FOR BUILDING DEPARTMENT. THIS C F CERTI tCATE ST NOT BE A TERED IN ANY MANNER. ~::s: ~ N~n:E 1j cc:K:~r:ur~ i ~ °cs t.. ti. i' ~ d 6+0 ouIrDATIOrr ~ c i,t~ I / ~ ~ fii ?OUJJDATIO:J (2nd 1 cn~ ~i D ° tv, ~OUGH FRAME & 1 "l .PLUMBING H 3, m IIJSULATIOrI PER N. Y. I " ~ STAT° EJJERGY CODE I x ~ ~I 1 FINAL ' ~ ~'1~ ADDITIOPIAL COMMEIITS: 2~ ~ ' a ~ :S'o x \ ' ro X636 • y A~ O m . - / ~ O v • m q~ 1; ' i fs:,~ic= t~4~,°, s=t . ~W~x wasnr,;~}I~, hs~~ °r_ ~~~aa (6~~) -3311 ~ r g _ .............~.=_,_~ez~... ~;'~L~l]~fi~ ~1; ~I AUG 2 91990 { yam i, _ ~ L~ BLDG. DEPT. TOWN Uf SOUT"10LD i E i If,° ...,-~rl/'~ ~~f~r~., r ;l'~~ ~~f's?~'~ /d?dil~;f {.~'J~°,.)U~i.,%~§'i ..'L Y~ STY7 „~ptR.~ ~»~y.~ ~ ~ pJ4 ..w..'-.~...,-re~.gw-wY s~ `~J f i. . w; n,i. _,.7 I 7 h . r - ji - 2J.,~.. , f ^,rY s & ti~ n1a.., i'~~do ~Y' ~'t~~ ~ ~tvJ # j; t2«, ;a ~ ryr;:, i~ (1,Nis]~[.'~=~"i-:??i~; r!':i1 i:;)4°~N }~fSF.;F;;,'1, ia' si lid:; l~ , F. i it rk ! ~t ~F y.. f f ~ ~ { f ~ ~ i i u ~ E.'~%._~/ i ~'.i~ f 8 ,_.,a~.r t Tai w° 3`.,,~ i x s'7 ' f^ ~ 99 s - r- s ~ 7 ~,#'~/`c y~/yam } i i f l ~ . i,. U C:% t! r d~ 3a y- . , ~ t,~ bf ~ "Yw/ r ~ C41.: 7' ~ d.~' g.,.- 7 T » yy d ~ y e~ J(~ )~v~'/i ../~...jj A°"`e ~F y('{~~yZ'~`_ ~ ~.g. i'T33 ~t~r~4/I'L.', ! stlt-- r`-~7 et#R~IJ G`` Y-!~ f l~G.? / 6+s ad~+'f4 ?~~A > ~n~) y t ? ~ i t r~ ,z I t`7r t / big r M ~F'~j~ I (./Fj tf ] E try S.~ ~~~s~sw L ~Y ~f~~v4! d 1 s ~ i `i 1 l t o ~ , ~ # i i q ~ F s II l 765-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING ( INAL REMARKS: DATE ~ ~ INSPECTO I 765-1802 BUILDING DEPT. I NSPECTIA [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION MING [ ]FINAL REMARKS: ~...~-~~~-~ti~ ~'h- DATE ~ G~ INSPECTOR ,a ~~~~v T65-1802 BUILDING DEPT. 1 NSPECTI®N [ ] F UNDATION 15T [ ] lROUG1~1 PLBG. [ ~j FOUNDATION 2ND INSULA L ] TION [ ]FRAMING [ ]FINAL REMARKS: t~'l~//-~ l _1~ DATE ~INSP~CTOR ~ ~ %i/ /~.r~~ 765-1802 BUILDING DEPT. INSPECTION [ FOUNDATION 1ST f ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ )FINAL REMARKS: D~.~~ - B*-f/~i i ~ ~ DATE / / 3 d INSPECTO~ I s~r+ f ~ .y i+~ JI r \ - 4 ' • ~ ~ rOF~ ,ti,rv ~ s # os~q Fp s<' s r ~f a b . m ~ ~~b~r~ ~ DONNA D~~RI VE ~ „ tior~ N. N. 2 ° 40 ~ E. 11 O.00 ~ e u SPLIT PAIL FENCE` SPLIT RAIL u _ p O-~ p.__ ~~'~--ice ~~---@ FENCE :y ~.._~-.a-.__.._-_._.~...~... N. 2°40'40"E. 312.67' I I Hoso ~ ~ ~ I i,: z ~ IC~ I Ob ~ < - ~ d' ~ o -tn F~ ~ y ~ ~ u a a ,y Y I t~k I m? ° _ co ~e.o• ~ _ - 0 ~ ro e°.o• o ~e.o• O ~ ~ ~ ~ t ~ ~ ~ ` ~ ~ ~ Z,.O• E m ~ . -r _ m V ~ . ~kj9.0• ao.o• o ~ ~ , r - v ~ "t z ~ ' ~ ~ ~ t S , ~ ~ ° ^k ~ s~ ~ ~,.F"s~ m b ~ J r ~ ~ a. nom, r r- « 1 ~ ~ Cho _ ~ ti~ wti _ ~ - ~ ~ N W ~ , a t t -.'1°i5 a~vsP -'y;,,..,»._,aofn.- r.:---_.~; -Ql ~ ; - , xt• , - t i O ~ t - ` ~ ~ N O O I ~ O OO a0 ! 00~i ~ 90.d~' ~ W000 FENCE 20.0 ~ _ ~ `moo S. 2 ° 4040° W. ; I10.00~ r.. _ _ 0 - ~ r r V O ~ _ ~ ~ - ~ ~ Of O~ynQt ~tim~~ _ _ ~ I ~AZ~o o ~ o ~~oy... C O v ~ ~~~y 5~o~v -~Z~ ~m N ~ YZ~Q ~Op N R1 ~ T~ ~ D ~ O ~ t` Jy ~ m N n ~ ~ m O ~ a~~P~~ . - ~n ~ -I < p4. ~°-.~ma°po t0 ~ O _ n ~Tl s~a~~ i J„ ~ o` ~ N w ~ ~ C ~ -n ~ ~ ~ ti¢¢r~v ?~_m:e~i:.i~b' aea~.SnC_r~~a;:e..'^~ C.,,. T'; m,.:r IV 3~^$~. "Fi:^a.arK.slue.~Ax 3, ~'Mt st. a.~..;:,<i:: yZm Of O s O Z O~X H d1 ~ -U(, p0 ~ ~ .~FA~Q Z "S f Y 2 j O y ~'.aaor•~~ac _ DONNA DRIVE .m - n F~ A .9 n N N.2° 40 ~ 4d~ E. 110.00 a f- = sour ani~ - V FEMCE _ A 2 N.2°90'90"E. 31~ ~ 1 Nona i O C I n ~ ~ 1 I 1 ¢"oa ~ = I to I y m u ,U W m m i~ o~ 1 e ~ I r A fo ie.o•_ ni b ae.Y• O O a c ~ a (~1 < ~ ° m . n $ ~ z~.a, n c m m m $ ~ a° z• _20.0'_ _ D C ° '^141 u ~ s. N - ~ m O m i < .O pJ~ r Y n N m n ~ ~ r ~ x r, O ~1 O ~ ~ ~ 01 ~ ~ ~ - fJ r ° m T ~ F Y~ *~F N W ° s -1 ~ N a m T tm ~ i I N o- O ~ m O O o - 4: ~ ~o / ~ 90.00 n ' wooo fEace 20.0 ~ ~ ~ _ ~y- i - _ _ utie S. 2 ° 40~ 40° W. 110.00 w z r 0 r ~ o ~ o I V -1 N ~-~~-JJ } Of G~~1 ~O n c 7? ;~f1Y~~ 'i~ i r~ An~im~m o 3 ~ Z nl ?QmO ~ ~ OH f~ ~ fn --~io'~"m~ C O ° ~ 4° ~ byN~ 'rl ~ ~ ~ m ~ T 00 A r a ~ n rn ~ Z g m zo z c0 hsw° t ~ ~ ~ w ~ ~ ~ = r C O 22e~o m°c c N m ~ ~ D ° 0 ~ ~a<°~ ~ ao 00 ov, v ~~~m - O -I v, m ~~°ao ~ Or D Tea ~ W Z C~ m ~''~~°S Ao ~ z~ -''o o --1 C m m N O ogy3° i ~ a~ T2 Z tio'a c ~ ~ = n YO F ~ ~8M9 W o `Yy Z ~ X umi ,"8S~ op D T A s4. x o °i ~ m Ra.&~ ..b..w.,. Y , , BOARD OF HE~ILTH . 3 SETS OF PLANS FORM NO. 1 SURVEY . TOWN OFSOUTHOLD CNGCK BUILDING DEPARTMENT SEPTIC FORM TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1802 CALL Examined 19... MAIL T0: Approved 19 Permit No............ . Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT n,'- / ~~JJ Dates ` / IS/.~ INSTRUCTIONS a. Tltis application must be completely filled in by typewriter or jn ink and submitted to the Building Inspector, with ~ sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Perini[ to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building'Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for r oval or demolition, as rein d cribed. The applicant agrees to comply with all applicable laws, ordinances, buildir. e, si c nd oulat' s, and to admit authorized inspectors on premises and in building for necessary inspe . (Si, ature of applicant, na f a coy~rp~o~r~atton) .......~~3. ..~-t'e6?.....~?. ~?z'.`e ~/M~jl~ng add~es~.yf aptrli~~rtt~ y State whether applicant i owner lessee, agent, architect, engineer, general coifn--tractor,,'eleotriciani", plumber or wilder. Name of owner of premises ..~Q/1~(!~J ~ ~!L..~~~....t.~. G U as on the tax roll or latest deed) If applicant i c po ion, i natur f du au~tjh~or%i/~ officer. g.. . !~.:f' . (Name and titl of co o e officer) / - L Builder's License No. cs'~.le~l~" Plumber's License No . . Electrician's License No . . Other Trade's License No . . 1. Location of land on which proposed work will be done; House Number / Street Hamlet County Tax t.lap No. 1000 Section • • • • Block / ~ Lot ~Z.........,.. . Subdivision r.N~..~. ?.!U/e ..~~.~~r•~~~5. Filod Map No. 7,~ 5 6 Lot (Name) State existing use and occupancy aC premises and intended use and occupancy of roposed construction: A. );xisting use and occupancy....../ J~/~~ ~ g / B. Intended use and occupancy......... nQ,u~ ~ 1i~ . } 1 4 3. Nature of work (check which applicable): New Building Addition Alteration Repair R~mov~l Demolition ..............Swimming Pool. . Tennis Court Accessory Building..........Fe~ce .......Other Work.~~:f4--... 4. Estimated Cost OCJ Fee , (to be paid on filing this application) S, If dwelling, number of dtivclling units Number oC dwelling units an each floor , , , , , , , , , , , , , , , If garage. number of cars . 7. Dirt cnsions of ex stingls~ructuresoccupancy, specify nature and extent of e~ac~L~'pe of use , if any: Front . . l.SP....... , . Rear ,k*i :7, . ~P~°... Depth . , , , , , Height ....1~........ Number of Stories . . Dimensions of same structure with alterations or additions: Front Rear . Depth . Height ...Number of Stories . 8. Dimensions of entire new constn~ction: Front Rear Depth , Height Number of Stories . 9. Size of lot: Front P.car ...fU Depth ~,~Z • , 10. Date of Purchase . ~.'~.'b~~f~.f'....... Name of Fonncr Owner ~.'~tP:~ . ~~~.'S....... , , 1 1. Zone or use district in which premises are situated . , hV . . . 12. Does proposed construction vioia;te any zoning law, ordinance or regulation : 13. \Vill lot be regraded . Nill excess fill be rem ved fjjom premises: / Yes , , No . . 14. Name of Owner of premises ~hI~~K .Address ~~GR'Phone No..~~./.'4~'E/.~,1.. , , Name of Architect >s~C•A. l~4•~h/7's•~t~ .Address .C+.'kW,~:~.!~+~.. Phone No..~f~~ . Name of Contractor /.yG/i./t/:K~/ :,~'72 f, . ~G...... Address .~7~. G:h, n,G,ue,!f~, ,phone No..~P.2~::°'~... . IS.Is tbis property to ted within 300 feet of a tidal wetland? *YCS....NO~. *If yes, Southold Town'',. Trustees Permit may be required, PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. S[~~e...~c.,-n. t~ e~ ~lawS /~31~ ,~f.~',/2~r1 ~ G ~ a G. vs A-T~. ttJ~OS+~z-,~.r.,'°`-'~. 4aacJGll COUNTY OFEIV.Y~~~~~4 S./S v~Zrz!:~? being duly sworn, deposes and says that he is the applicant (Name of individual si;ning contrdct) above named. He is the ...............~~?:~~,~/~L~~....:........ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dNly authorized to perform or have performed the said work and to make and file this application; that all statements cotjtained in this application arc true to the best of his knowledge and belief; and that the work will be perforned in the manner set forth in the application filed therewith. Sworn.~to before me this Notary Public, ~~•C• • • • • .~~ounty auwvt~.cgt~osno NOr ~NewVOdc . ~°~'~^~w/w.so.tu~a. (Sin • re of applicant k30r\RD OF ItE\LTkI l''-/~/1l........ 3 SETS OF PL.1NS L//. • . FORM N0.1 SURVEY t/...... TOWN OF SOUTHOLD CHECK . ~!,I~ . BUILDING DEPARTMENT SEPTIC PORPI ..n TOWN HALL 9~,~ SOUTHOLD,N.Y. 11971 NOTIFY / I TEL.:705~1II02 CALL (p Examincd~~~~!/'./........, l9Y/.. /p MAIL TO: Approved 1~. Pcmtit No. 1. P~,m~... Disapprovedalc C~-- ~ / (Bui mg Inspector) BLDG. DEPT. u/ TOWN OF SOUTHOLD APPLICATION FOR BUILDING PERMIT Date . OC.~.`~I~ ci5,~5... INSTRUCTIONS a. Tlus application must be completely Tilled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available ibr inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by thr, Rn;irling Inspector. APPLICATION-IS HEREBY MADE to the Building Department for the issuance of a Building Perntit pursuant to the 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New Yark, and other applicable Laws, Ordinances or Re^_ulations, Cor the construction of buildings, additions or alterations, or for remova or demolition, as herein described. The applicant agrees to comply whit all applicable laws, ordinances, building co u ' o , a d r lati s, and to admit authorized inspectors on premises and in building for necessary inspec[io ~ (Sign rre of applicant, nom t orporauon)~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plmnUer or builder. Name of owner of Premises ~c>hr~cw.~ ~`~'~}e-'2'~-t5 e1S . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate office Builder's License No . . Plumber's License No. . ~..be Se~ee-~@~• Electrician's License No. . Tom„ b2 Se.1'~"k~` Other Trade's License No . . I. Location of land on which proposed work will be done. . , . ,14J'Q..~U, ,nn House Number Street. Hamlet County Tax hlap No. 1000 Section .r4........... Block ~ , , , , , , , , , , , Lot . Subdivision 0, ...........}'~0 l-2 C..~[Ee_~~... F.rlcd 61ap No. ~;~,`v Lot State existing use and occupancy oC premises and intended use and occupancy oC {proposed construction: a. Exisun;uscand occupancy 6. lnte use and occupancy a'~t,~ ~ ..~,v. 1.~~s,.:)~t~ . ' ~t.,.,.L1` ;rui ~':.6'. t;}t~t;;= +r4! %,tE:: v4s~,rs&;c^~rF;~pit~n~?ttr~i ~~~......111 Addition Alteration 3. Nature of work (check which applicable): New Mudding . Repair Removal Dcmohtion Other 1Vork . (Description} Q. Estimated Cost ~UV r Qt)~ Fcc . S. If dwcllin,, number of dwcllin (to be paid an filing this application) units ~ Number of dwellin • units on each floor . U Ifgaragc,nurttbcrofcars 6. If business, commercial or [nixed occupancy, specify nature and extent of each type of use . 7, Dimensions oC existing structurFs, if any: Front Rear Depth , , . Hr.i"ht. ; ~ , Nwitber of Stories . Rear............ Dirn,en§totis,4(same siructurc tgnh ;dtcrttions or additions: Front . DeBtli : 1[ciP,ltt , Number of Stviics . 8. Dimens t ~w cons[[ action: Front . 7.2-, ..........Rear Ucpth . i{vi ltt , , . Number of Stories . . 9. Size of lot: Front . Rear ....~\(j . Dcpttt • . 10. Uate of,Purchase . ~ °-~".~t?t .4 ~'h . .......:.....Name of Ponncr Owner C?.'~?e~~Jr• • Sw~~"'r• • . • . 1 Zane or use district in which premises arc situated . . 12. Does proposed construction viplatc any zoning law, ordinance or regulation : l3. 1Yi11 lot be regraded ~4 IVill excess fill be removed from premises: .Yes l4. Name of Owner of pr iscts ~~S?a ~"t'~}' ~~4:. Address 323 C~+.~Guve,~ Phone No. b7.1.'"~'.`~ Name of Architect ..14t.~~Y4C~ .~~~R.'2-..Address . Y'~ ~`~~r~~ ~ Phone No. ~ 7! _ . Name of Contractor .~h~!~ Cr44~:' .~v'!W .....Address . r~.?~ Crte~'!.t.w?~ Phone No. S°.? ~"vy~l..:.. . IS.Is this property loc ed within~00 feet of a tidal weClaud? *YGS..~.NO~J~w,~~ *If yes, Southold Town; Trustees Yermit may be required. I'Q"^'`_`",~ PLOT DIAGRAM Locate clearly artd distinctly all',build'urgs, whether existing or proposed, and. indicate alt set-beef: dimensions from property Lines. Give street attd block number or description according to decd, attd show street names and indicate whether interior or corner lot. ' . i - ST>,Tr: or- ~'rlv YOR1:, S COUN~f1' OF +~l^^..... / r (Name of ir~clu:1~~nf~ O~~IH~ bcutg duly sworn, deposes and says that he is the applicant c [tract) ~bovc'namcd. • 'lc is the (Contractor, agent, corporate officer, etc.) rf said owner or owners, and is duly :jtrthorized to perform or have performed the said work :uul to make and file this pPlication; that alt statements containccl in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner s~[ forth in the application tiled therewith. ~worrt to before me this ~J q l.....day of C!~7~.~??e~.... . 19 g .l 'otary Public, ~u.,~~oL~~ • • • County ~~~NptMett Pu~6l~ke. She ofNew~Yorlt. . • . (ro,{621818,SuffolkCouMY (Signat•re applicant) 'ptrtn Explra6 $~pt~trtbe? 90,1 r~ . 4^~ ' Nt ~ ~ C7 e ~ : ~ ~ - ~ ~ SPLIT Rpt4 ~ » ~ M.2° 40 A{~ E. PENCE- _ ° } rowxA Z iy. _ ~J _p g :D N ° } m 4 £~~z ~ ' ~ N ~ 1 ° q ° ~ N.2°aoao„~ 312.67' ~ 1}~ }'o z~ m m? 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